This project focuses on oral changes associated with HIV-1 infection. We have examined saliva, a critical part of the oral defense system, for changes following infection in cross-sectional and longitudinal studies. In all studies, the antimicrobial proteins lactoferrin, lysozyme, histatins, and salivary IgA were elevated in males positive for HIV-1 antibody. Of these proteins, only lysozyme continued to increase with time. Changes were most dramatic in the stimulated submandibular saliva. Salivary secretions from HIV-1 positive patients with a salivary gland enlargement which mimics that seen in Sjogren's syndrome were analyzed. Higher elevations of salivary IgA, lactoferrin, and IgA rheumatoid factor (RF) were present in HIV-1 positive patients with salivary gland enlargement than in HIV-1 positive patients with no enlargement. However, the saliva from patients with primary Sjogren's syndrome had much higher levels of salivary IgA, lactoferrin, and IgA RF. Recently, a study has started to examine periodontal status associated with HIV-1 infection (also see Z01 DE 00498-01). Preliminary data suggest that HIV-associated periodontitis is not frequently seen, and HIV-associated gingivitis is more common. These studies hope to establish a logical rationale for treatment of the oral problems seen in AIDS. We have also examined the incidence of AIDS among older persons, and observed that greater than 10% of cases in the U.S. occur in patients aged 50 years or older.